Small was recently named to her dream job - CEO of St. Mary's Medical Center in Blue Springs.
Annette Small leans back comfortably in an armed chair at her St. Mary’s Medical Center executive office, her legs crossed loosely, her slender frame relaxed. She’s dressed attractively in a fitted navy jacket and black slacks, her hair and makeup flawless.
Several years ago, the scene was quite different. Small says she often worried about whether her large frame would fit into airplane seats with the belt secured around her waist. She would constantly pull her clothing down to conceal her midsection.
At more than 100 pounds overweight, Small kept her home thermostat set at 65 degrees – she was always red-faced and would sweat constantly. She felt uncomfortable in meeting rooms because beads of perspiration formed on her face.
Small, 40, clicks an ink pen on and off against a tabletop constantly while effortlessly telling her story of how she gained more than 100 pounds in her adult life. The oldest of five children, Small grew up in an active household, but her freshman year of college at Emporia (Kan.) State University marked the beginning of how she “blossomed” into clothing sizes 28 and 30.
Small gained so much weight her freshman year that her boyfriend’s friends asked if she was pregnant “because I was so big,” she says candidly.
“And I’ll never forget that,” she says. “It was horrible.”
She is completely honest in the raw details of how the weight gain spiraled out of control. Small shows pictures of her former self – she’s smiling widely in the photos, but she appears at least five years older in them than she looks today, a point she admits.
A year ago, Small celebrated a 17-month journey to losing 104 pounds. Even as she waged war against her weight for years, Small also celebrated small victories along the way in her career as a registered nurse. A month ago, she was named the newest chief executive officer at St. Mary’s Medical Center in Blue Springs, an interim position she had held for four months.
She might be living up to her last name in a new body, but Small is celebrating her personal, familial and career successes in a big way.
‘That darn ol’ college life’: The new nurse keeps her sense of humor with patients but puts herself last
Freshman year at Emporia State University wasn’t Annette Small’s finest hour. She says she didn’t study like she should have to earn decent grades and ultimately ended up moving back in with her parents in Olathe, Kan., after her first year.
Her career aspirations weren’t set in stone, but Small says she felt some loyalty toward the health care industry because of her father’s affiliations in pharmaceutical sales. During her college hiatus, Small worked as a certified nursing assistant at a nursing home.
“I will tell you I loved that job,” she says. “It was a great job, and I really bonded with some nurses there. I will tell you my very blessed career path – that’s where it started.”
Nurses showed Small how to perform tube feedings, how the IVs worked and how to execute dressing changes. “You would make a great nurse,” they told Small, who says she loved the patients.
“The older people had so many great stories to share,” she says. “They wanted to spend time; I had the time to spend. I could really care for them on the basic, human-need level.”
She fed them, assisted them in going to the bathroom and bathed them. Small says she felt good about her role – and she kept her sense of humor with her patients.
“I loved doing it, and they appreciate that so much,” Small says. “The thing is they’re embarrassed or they really hate having to be dependent, but I would tease them. We’d laugh; we’d have fun – and then it wasn’t as hard for them. It was fun.”
Small soon applied to Saint Luke’s College nursing program in Kansas City, which at the time was a diploma degree that focused on clinical nursing, Small says. (Small went back to school later to earn her bachelor of science in nursing.) She was awarded the Dick Howser Memorial Nursing Scholarship – twice – and got to throw the first pitch at a Kansas City Royals baseball game. (Howser, who served as the Royals manager from 1981 to 1986, died of cancer at age 51 in 1987.)
While attending nursing school, Small helped with patient transport, carrying IV poles around the hospital, absorbing information about the hospital, the patients, the physicians – everything.
“I’ve done all the different kinds of jobs in the hospital,” Small says, “so I feel very comfortable and well-versed in the runnings of a hospital. It was great ... I picked up all I could just soak in from the patient-care world.”
But as she took care of everyone around her, Small was neglecting herself. Stress, partying, cafeteria food, eating junk, not caring and not exercising combined forces to Small’s gradual weight gain. She started smoking in nursing school because of peer pressure, she says.
It was a 180-degree revolution from her childhood. Small and her siblings played outside, running in the woods, riding their bicycles in the streets. She grew up without carbonated beverages and junk food.
“It was really that darn ‘ol college life,” Small says, laughing.
After graduation, Small had registered nurse roles in neurosurgical intensive care unit nursing and home health. With the home health position, Small says she was in her car frequently and resorted to fast food.
“So, I just kept blossoming and blossoming and blossoming,” Small says.
Fifteen years ago, she met her husband, Tim Small, and the couple had three children together – Maddie, 14; Jack, 10; and Emma, 8. Small quit smoking 14 years ago, but because of her weight, she had gestational diabetes with each pregnancy and was on insulin.
Tim Small says he was attracted to Annette as a friend, more than anything.
“It wasn’t like I was dating somebody. I could hang out with her, and I just felt very comfortable,” Tim says. “We just hit it off as friends. That’s what was attractive to me.”
After her third child, health professionals told Small, “Your body probably can’t do this anymore.” She vividly remembers being told, “If you don’t get this weight off now, you will be diabetic.”
Even then, the necessary lifestyle changes to lose weight didn’t take place.
“In my head – clinically and in my knowledge base – I’m well aware what diabetes is and what that means,” Small says. “That’s not something you want to strive to do. I also know what it takes, in my head, what it takes to do weight loss – didn’t do it.”
Despite the weight gain, Small’s career positively evolved. She worked in on-site case management for an insurance company for about five years and became familiar with St. Mary’s Medical Center. She joined the hospital in May 2000 and also worked as a performance improvement nurse. Career- and family-wise, Small was on top of the world, but she was out of breath on her climb there – and a change would soon be necessary.
‘I couldn’t think clearly’: A career moves ahead while the weight holds her back emotionally
Small, a northeast Lee’s Summit resident, started her hospital administrative role in July 2006 as St. Mary’s administrative projects specialist. As she climbed the hospital’s stairs, Small says she could tell “how horrible” her health was. She would huff and puff, feeling her chest pounding and her head throbbing. She was constantly tired.
Her blood pressure “was extremely high,” and Small says she really thought a stroke was in the future. At 38 years old, Small’s knees and back would hurt constantly. “I’m too young to have that kind of pain,” she thought.
Because of her children’s active, always-on-the-go lifestyles, the family would routinely eat fast-food meals four times in a weekend.
“It was horrible. I mean, it was just physically horrible,” Small says. “I could not think clearly.”
Internally, Small says her self-esteem was “very bad.” Everything in her life was clicking except herself.
“I mean, I felt good about my career, and I felt great about my kids and about my husband – always a great relationship there,” Small says. “Kids? Fine. Family? Fine. Work? Fine. Me? Not so much.”
The kicker, Small says, came with the clothes’ shopping. She was required to wear nice, attractive business attire in her new administrative role.
“They don’t make nice fat-people clothes,” Small says. “I mean, that’s not politically correct, but that’s just very honest. They’re not comfortable. They don’t look good. They don’t fit right. They just make you feel horrible.”
She says her reflections on past situations are clearer now because of her weight loss. As she went back to school and earned her bachelor’s degree of nursing several years ago, Small says she was unable to fit into armed chairs.
“I was too big, so I couldn’t sit in them,” Small says, “so, I would get to school early and get the chair that didn’t have arms.”
The nursing students were required to perform assessments on each other for one class, an experience, Small says, that was embarrassing. “You don’t want to have people touch your fat,” she says bluntly.
Close relatives would make comments of concern. Small received plus-sized clothing as gifts throughout the years, boxes she didn’t want to open and bags from stores she didn’t want to carry around.
“There’s little stings, over and over,” Small says, “and internal – you wouldn’t verbalize that.”
Her career felt comfortable. She was attending school again. Everything, Small says, finally clicked.
“Enough is enough,” she thought to herself. “I cannot do this to my kids. I want to give them the tools to live right so that it’s just common practice, and it’s not even a thing that you do.”
“This is what I’m going to do,” she told her family. On her own, she decided it was time. A classmate had talked about her own experiences in Weight Watchers. In June 2007, Small signed up. Launched in 1963, Weight Watchers is an international company with local chapters and weekly meetings that center around weight loss and maintenance.
Friends stepped forward with their honest opinions, voicing how they really felt as 104 pounds slowly came off for 17 months.
“They said, ‘Well, we knew you were smarter than that,’” Small says. “It really has nothing to do with ‘smart.’ It’s not about smarts – it’s when you are mentally ready.”
‘Always felt called to do something big’: The nurse steps up as CEO and still doesn’t see herself as thin
Another career advancement took place for Small in September 2007 as she was promoted to director of clinical operations at St. Mary’s. About 70 pounds into her weight loss, St. Mary’s officials asked Small to participate in a women’s heart advertisement and to speak about her weight loss journey. Her family rarely ate fast food anymore. They took walks together at least five days a week.
“What inspired you to do this?” someone asked Small.
“I didn’t want to die,” Small replied. “And I’m serious. It was the truth. I didn’t want my kids to have to go through that.”
She estimates that she went through four or five sets of wardrobes in nearly a year-and-a-half. Her husband jokingly told her, “Well, we just need to get a binder clip to pin your skirt together,” because it would be literally falling off of her.
Tim says Annette’s weight-loss goals are typical of her personality to take on a project and accomplish it “full speed ahead.”
“There was no doubt in my mind that once she decided to do it, it wasn’t a question of if she was going to do it; it was when she was going to meet her goal,” Tim says. “She doesn’t just do something for a little while and try it out – she’s going to finish it, no matter what thing she has taken on.”
Losing weight, Small says, is a positive experience, “but it’s a lot of attention that you’re not expecting,” she says. Prior to the heart fashion show, Small had to try on many different outfits that were form-fitting and touched her body. She left one store bawling her head off, she says.
“While I am not a shy person, and I certainly don’t mind being in the limelight, something hit me,” she says, laughing. “It was very odd. I really don’t know. Emotionally, though, your emotions have to catch up to that body and that person you are – and no one tells you that. No one tells you that you have to go through the psychological transition to live in your new body.”
“It’s hard to believe, still,” Small says of looking at photographs of her former self. She feels somewhat sad that she hadn’t pursued weight loss earlier, “but we all have a journey and you just can’t do it until you’re ready,” she says. A year after making her goal weight, she still choose sizes too large for her size 12 body while shopping.
“I still don’t see what other people see,” she says. “When people call me ‘skinny’ or a ‘shadow of myself,’ I’m like, ‘Who are you talking to?’ It’s still a transition.”
Annette Small laughs at picturing herself as a hospital CEO when she started her career as a registered nurse.
“I’ve always felt called to do something big,” says Small, a devout Catholic. “I always felt that I would do something, but I didn’t know what.”
In July, Small began serving as St. Mary’s Medical Center’s interim CEO, a position that was named permanent in early December. St. Mary’s is part of the Kansas City-based Carondelet Health, a nonprofit Catholic-sponsored health-care system.
“I think this is it,” says Small, who has shared her “calling” experience with several Catholic nuns on the hospital’s board of directors. “I really feel that this role has some calling to it, and there’s some fire inside about it. I know it sounds so corny, but that’s really how I feel. This is such a comfortable fit for me.”
Lee’s Summit resident Jamie Logan met Small 17 years ago while Small interned at St. Luke’s Hospital and says she considers Small a close friend with a “fun personality” and “a sarcastic, fun sense of humor.”
“She’s very dependable and motivated,” Logan says. “When she decides she’s going to do something, big or small, she gets it done. She’s been that way forever. Once she gets focused, she gets it done, whether it’s by herself or enlisting the resources of others.”
Small described her CEO role as “fun and non-stressful,” adding that many people have commented on her positive dual role as a nurse and as a woman in a top administrative position.
As a Girl Scouts leader, Small says she emphasized turning young girls into strong female leaders “and to know that they have the power within to succeed and to do anything they can and want to do.” She provided the kindergarten through eighth grade-aged Girl Scouts with opportunities to speak in front of crowds and gave them leadership roles.
Weight loss, three children, a husband, a new career role – and oh yeah, Small will graduate in May from Baker University with a master’s degree in business administration. Her weight remains a top priority, even during the holiday season as Small worked late nights. She prefers walking outside as an exercise regiment, so she will put on her sweaters, thermal underwear and three pairs of socks at 10 or 11 p.m. on weeknights or at 6 a.m. on weekends and will go walking with Tim “if that’s what it takes – whatever we have to do to get it in,” she says.
“You know, if I think of it as hard then it would be – I can’t think of it as hard,” she says of her juggling act. “I think it’s just a matter of balance, and you just do it. I don’t think about it. You can do anything – you really can – because it’s just whatever is important to you.”
Logan says she often jokes with Annette and Tim Small that “Once they decide to do something, they get ‘er done.” Though Annette’s weight loss took a long time, Logan says, she did it the right way.
“She’s more busy now that she’s ever been in her life, but she’ll call me at 10:30 at night when she’s finally getting her walk in for the day,” Logan says. “She knows it’s important and that it’s a priority, and I think that’s amazing.”
Logan described her close friend as “just a good, solid, normal person” who is “very real.” Again, Small says, “You just do it.”
“You just have to make it a priority and do it,” Small says. “You can’t have excuses because you can always make an excuse for everything. I can rationalize myself out of anything if I want to.”
The children are in tune to Small’s weight loss, too. They take frequent walks with their mother and share fruit slices. Small doesn’t allow desserts like ice cream in their home and drinking soda is forbidden.
“Their measuring stick was when they could put their arms all the way around me to hug me,” Small says. “That’s priceless. They love their healthy Mommy.”
Her life is hardly a bed of roses, though. Small admits that some nights after work, she’d much rather put on sweatpants and watch TV with her children, but instead, she takes a 45-minute walk. Even if they occasionally experience “Mommy guilt,” Small says other women should also learn to put themselves and their health first.
“They have to put themselves as a priority – have, have, have to – as uncomfortable as it is and as much as you think you don’t have time to do it, you do and you have to or you cannot be effective for anybody else,” she says. “I’ve heard it said before, and I never believed it until I’d done it.”
“It’s not really a choice,” Tim says of his family taking routine walks together. “We just do it.”
“She’s really busy with her career, and I think there’s no one else, really, who is busier than her from a professional standpoint, but she always finds time to walk, to exercise, to take care of her body,” he says. “I’m really proud of her. I’m very blessed to have her in my life, and she has come a long way.”